Developing, Implementing, and Pilot Testing an Informed Decision Aid for Opioid Agonist Therapies for Prisoners in Ukraine

项目总结/摘要 东欧和中亚地区艾滋病毒感染率增长最快 这一流行病在世界范围内蔓延，加上监禁率和注射毒品率很高。的人 注射毒品（PWID）集中在监狱，这是一个注射毒品率最高的地区。 监禁，其中70%的PWID经历终身监禁，36%通过 监狱每年美沙酮或丁丙诺啡的阿片类激动剂治疗（OAT）是证据- 基于实践（EBP），有效地减少艾滋病毒和丙型肝炎病毒传播的PWID 54%， 61%，死亡率降低3倍。38名囚犯的OAT试点开始在乌克兰 2020年，监狱的覆盖率和规模在EECA中很低， 乌克兰建议不仅必须显着增加监狱的覆盖范围，而且PWID也必须 在释放后保留。然而，监狱环境会影响有关OAT的决定 由于监狱内的背景因素以及对监禁是治疗的误解， 知情决策辅助工具是基于证据的工具，可促进OAT的实施 并在监狱中扩大，因为它们指导PWID决定是否采用OAT以及 根据个人喜好选择。拟议的研究旨在了解 乌克兰被监禁的PWID的治疗偏好，调整知情的决策援助 这些偏好和背景，试点测试这种援助，并建立一个数学模型，显示如何 扩大援助规模将在10年内影响艾滋病毒和HCV的传播。我提议： 1)对600名使用阿片类药物的囚犯进行基于联合选择的分段分析 了解乌克兰阿片类药物使用障碍囚犯的OAT偏好。 这些发现将指导适应知情的决策援助，我将2） 系统地调整现有的类阿片使用障碍知情决策援助， 通过alpha和beta测试与囚犯适配的交互式原型的乌克兰监狱环境 （n=25）和供应商（n=10），并评估这一实施工具在改变 使用前/后设计试点研究（n=100）决定OAT;以及3）评估有效性 这种知情的决策援助，以扩大在监狱中的OAT及其假设的影响， 乌克兰PWID 10年内的HIV和HCV传播，使用基于马尔可夫的 动态状态转换模型这些发现，如果知情的决策援助影响， OAT规模扩大，可用于指导整个东部地区采用这一实施战略 欧洲和中亚监狱，由于监狱的遗迹， 前苏联的制度。

Project Summary/Abstract The Eastern European and Central Asian (EECA) region has the most rapidly growing HIV epidemic world-wide, compounded by high rates of incarceration and drug injection. People who inject drugs (PWID) are concentrated in prisons, a region with some of the highest rates of incarceration, where 70% of PWID experience lifetime incarceration and 36% pass through prisons annually. Opioid agonist therapies (OAT) with methadone or buprenorphine are evidence- based practices (EBPs) that effectively reduce HIV and HCV transmission in PWID by 54% and 61%, respectively, and reduce death 3-fold. An OAT pilot of 38 prisoners started in Ukrainian prisons in 2020, yet coverage and scale-up in prisons is low in EECA and modeling data from Ukraine suggests that not only must coverage markedly increase in prisons, but PWID must be retained on it post-release. The prison environment, however, influences decisions about OAT due to within-prison contextual factors alongside misperceptions that incarceration is treatment. Informed decision-making aids are evidence-based tools that may facilitate OAT implementation and scale-up in prisons as they guide PWID in deciding whether or not to adopt OAT and what to choose based on personal preferences. The proposed research seeks to understand the treatment preferences of incarcerated PWID in Ukraine, adapt an informed decision-making aid to these preferences and context, pilot test this aid, and build a mathematical model showing how scale-up of the aid would impact HIV and HCV transmission over a 10-year horizon. I propose to: 1) Use conjoint-based choice with segmentation analysis with 600 prisoners with opioid use disorder to understand the OAT preferences of prisoners with opioid use disorder in Ukraine. These findings will guide adaptation of the informed decision-making aid where I will 2) systematically adapt an existing informed decision-making aid for opioid use disorder to the Ukrainian prison context by alpha and beta testing the adapted interactive protype with prisoners (n=25) and providers (n=10), and assess the utility of this implementation tool in changing decisions about OAT using a pre/post design pilot study (n=100); and 3) assess the effectiveness of this informed decision-making aid to scale-up OAT in prisons and its hypothetical impact on HIV and HCV transmission over a 10-year horizon in PWID in Ukraine, using a Markov-based dynamic state-transition model. These findings, if the informed decision-making aid influences OAT scale-up, can be used to guide adoption of this implementation strategy throughout Eastern European and Central Asian prisons, which have similar structures due to vestiges of the prison system of the former Soviet Union.